The Ban on Abortion Coverage

When the House narrowly passed the health care reform bill on Saturday night, it came with a steep price for women’s reproductive rights. Under pressure from anti-abortion Democrats and the United States Conference of Catholic Bishops, lawmakers added language that would prevent millions of Americans from buying insurance that covers abortions — even if they use their own money.

The restrictions would fall on women eligible to buy coverage on new health insurance exchanges. They are a sharp departure from current practice, an infringement of a woman’s right to get a legal medical procedure and an unjustified intrusion by Congress into decisions best made by patients and doctors.

The anti-abortion Democrats behind this coup insisted that they were simply adhering to the so-called Hyde Amendment, which bans the use of federal dollars to pay for almost all abortions in a number of government programs. In fact, they reached far beyond Hyde and made it largely impossible to use a policyholder’s own dollars to pay for abortion coverage.

The bill brought to the floor already included a careful compromise that should have satisfied reasonable legislators on both sides of the abortion issue. The vast majority of people expected to buy policies on the new exchanges would pay part of the premium and receive government tax credits to pay for the rest. The compromise would have prohibited the use of the tax subsidies to pay for almost all abortions, but it would have allowed the segregation and use of premium contributions and co-payments to pay for such coverage. A similar approach allows 17 state Medicaid programs to cover abortions using only state funds, not federal matching funds.

Yet neither the Roman Catholic bishops nor anti-abortion Democrats were willing to accept this compromise. They insisted on language that would ban the use of federal subsidies to pay for “any part” of a policy that includes abortion coverage.

If insurers want to attract subsidized customers, who will be the great majority on the exchange, they will have to offer them plans that don’t cover abortions. It is theoretically possible that insurers could offer plans aimed only at nonsubsidized customers, but it is highly uncertain that they will find it worthwhile to do so.

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In that case, some women who have coverage for abortion services through policies bought by small employers could actually lose that coverage if their employer decides to transfer its workers to the exchange. Ultimately, if larger employers are permitted to make use of the exchange, ever larger numbers of women might lose abortion coverage that they now have.

The restrictive language allows people to buy “riders” that would cover abortions. But nobody plans to have an unplanned pregnancy, so this concession is meaningless. It is not clear that insurers would even offer the riders since few people would buy them.

The highly restrictive language was easily approved by a 240-to-194 vote and incorporated into the overall bill, which squeaked through by a tally of 220 to 215. It was depressing evidence of the power of anti-abortion forces to override a reasonable compromise. They were willing to scuttle the bill if they didn’t get their way. Outraged legislators who support abortion rights could also have killed the bill but sensibly chose to keep the reform process moving ahead.

The fight will resume in the Senate, where the Finance Committee has approved a bill that incorporates the compromise just rejected by the House. We urge the Senate to stand strong behind a compromise that would preserve a woman’s right to abortion services.

A version of this editorial appears in print on November 10, 2009, on Page A34 of the New York edition with the headline: The Ban on Abortion Coverage. Today's Paper|Subscribe